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Topic: Terminating (Read 5997 times)

If there is NO contract between a billing service and "the company", what is the billing service obligated to give them as far as records/data when the relationship is terminated? It's a relationship gone sour due to questioning of CPT coding, misuse of a modifier, and coding being done by an uncertified office employee.

I say to refer back to the contract because I've seen contracts where even the smallest of details were not covered and if challenged will always be in the favor of the provider and what is best for their business dealings. I have seen cases where billing companies were made to make data fully available to the provider even with balances owed to the billing company which is why it's so important to address ALL of these issues in the contract itself.

I'm sorry to say if there's no contract, and if challenged, you could be forced to turn whatever they want over. IN MY OPINION.. I would try to cooperate with much of their requests and avoid legal entanglements. Also, I would have to say you need to cover your butt. You mention some problems with coding, etc. When you ended the relationship (or if they did) was their written terminations in place? Were reasons stated? Did you bill out ANYTHING you knew or SHOULD have known were fraudulent or could be interpreted as fraudulent? By keeping them from their data that COULD be construed as an admission of guilt on your end. I don't want to assume anything but it would help to have more information. If nothing more, hopefully, you won't take on a client without a contract next time. Your not the first to have learned this lesson the hard way! We all have learned similar lessons this way, I know I have, and that's why my contract went from 3 pages to 13!!

Years ago I was approached by a business owner to do the billing for 4 physicians. The previous girl set them up with the software and clearinghouse, she just couldn't keep up with the work load. They offered to pay me by the claim and had months of back billing to be done asap. The next time we met they brought boxes of work to get done and a computer. I got started and caught them up. The general manager in the office was the one doing the coding. Attached to the face sheet was the DOS, ICD's, and CPT's. With a sticky note. They were always 4 months behind in getting billing to me. Years went by. The GM stopped dropping off the files and began sending them through the mail. They began using spreadsheets for the billing info. The GM left. The office manager was fired. Physicians came and went. Things seemed to be improving but I was beginning to question how the whole operation worked when I started to get billing info with a Q6 modifier. The GM is not a certified coder. I questioned using a Q6 and was told that it was correct. Then denials started flowing in last year. Reviews were being sent out every week. For the same service, different patient. I started doing research and found that the CPT code they were using could not be billed with the other service performed beginning in July. I made a phone call to a reimbursement consultant in the fall to ask her about billing a service provided in the home. She began asking a lot of questions. Her advice was to stop billing, give them whatever reason I wanted to, but to do it "next week". I was a bit surprised. Medicare, and other insurance carriers, had been paying these guys for years. If the way claims were being billed was wrong, wouldn't they be getting denied payment? She told me they were flying "under the radar" due to how the practice was set up. They are not set up as a practice, but as individual physicians, and they all work for this company. Paychecks are made to the physician but automatically deposited in the company bank account. The physicians are then paid by the company for their services. There is a "billing service". I am not that billing service. I happen to be a subcontractor. I've never received a W2 or 1099 from them. I do report my income and pay taxes on it.

The business owner called me last month and told me that billing was being brought in house. He wants a copy of the database so that they can see if a patient has been seen within the last 3 years, so they know which H&P code to use, as well as to have for possible audits.

Do you want my honest to goodness advice? Give them a copy of their database and wipe your hands of this mess now. If it gets to be an argument you really don't have much to stand on. Even though you do NOT have a contract, i would still FORMALLY terminate this relationship with the reasons in a letter via certified mail. THIS will cover you. Now to address something you can't fix now, but can learn from for future reference. THE moment you suspected there was a problem was the VERY moment you should have stopped billing. The law is VERY clear that billers MUST know what they are doing and ignorance is not an excuse. The moment you suspected was the moment your liability tripled with each claim you sent. The way to have correctly handled it was to send a letter with your concerns and "PEND" operations until the issue was resolved. Next thing was to consult with your contract and compliance plan to see what you should do next. and finally if no resolution was made, a letter terminating services with reasons why, and sent certified mail would cover you. As it stands now, with no contract, nor proper procedure in place both yourself and the billing company you sub-contract for are not out of the woods. That is why I suggest you comply with what they want. If I were you, also, I would terminate the relationship with the billing company for also not really properly setting you up as a contractor. Did you have a contract with them?

I say keep them happy and run, make sure you keep ALL of your own source documents and database copies as you are required to do JUST in case.

The business set up a billing company, but I don't work for them either. It's like it's just...there. The clearinghouse has them set up under this billing company. Other than that, I don't know what else it does. A way to cover the company?

The owner wants me to bill several more claims for a doctor that they did not set up on their new system because he quit. He also wants me to follow-up on old accounts to clear up any open balances. I wish I could show someone a claim, explain everything, and have a definite answer as to whether they are doing something wrong or not. Do you know anyone that I can get in touch with? Today? Or does it even matter? Send a copy of the database with a letter. End of story?

The business set up a billing company, but I don't work for them either. It's like it's just...there. The clearinghouse has them set up under this billing company. Other than that, I don't know what else it does. A way to cover the company?

Who do you work for? Who is paying you?

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I wish I could show someone a claim, explain everything, and have a definite answer as to whether they are doing something wrong or not. Do you know anyone that I can get in touch with? Today? Or does it even matter? Send a copy of the database with a letter. End of story?

I see so many things wrong from the setup structure of the business and add to that your suspicions alone, I frankly would NOT be doing another thing for them, you could be setting yourself up for a big fall. JMHO.

I work for the company itself. Not the doctors. Not the billing company. The MAIN company. They pay me under my name.

So then, how do I get out of this with complying? They don't use my software but said they are going to buy a copy of it (after suggesting that I might "rent" mine to them, or even better, sell my laptop to them).

Refuse billing the new claims for the physician who quite. Refuse doing any follow-up work. Refuse sending patient statements, one last time. In my letter, can I state "for personal reasons"? This wouldn't be complying with what they want. But give them a copy of the database?

Where I am confused is they are paying "you", (company) and it sounds like they are paying you as "employee"..? How are you setup tax wise, maybe that's what I should have asked from beginning ? I think this matters because if you were an employee/contractor that means didn't they pay for the software/computer, etc.. wouldn't it belong to them to begin with?

Since you said you wanted to be done with it, my advice is still the same, how you go about it might be different depending on your legal status with the company you work for.. If you are an employee than I would think you would want to terminate your employment status, if you are legally setup as a contractor than I would think you need to terminate the contractual relationship and this is where you would send letter as to your reasons and IMHO I would actually state your suspicions as generally as possible to avoid arguments/disputes.

I'm just confused as to why there would be a question of why they shouldn't get their data if it was a subcontract setup.

I know. It's been confusing since I started. They provided me with everything to get started. They brought a computer over with the software already installed with existing data. After that, I always upgraded the software on my own, every year or 2. They did not pay for any of the upgrades. The program is registered to me. When I bought a new system they didn't want their old one back. Of course, I just paid for the upgrade to the newest 5010 compliant version of software. I have a single user license.

They pay me, under my name. I don't have a company name. They don't take any money out for taxes. They don't send any tax documents to me. I never signed any documents for tax purposes, nor anything else for that matter. I've never been an employee anywhere that didn't have take taxes out of my paycheck. I've received W2's and 1099's from previous employers.